Presented a paper by Mario Kovac on E Health. Where He proposed a very comprehensive framework for healthcare interoperability. These slides contain brief description of mario's work.

1. E-HEALTH
DEMYSTIFIED:
AN E-GOVERNMENT
SHOWCASE
Mario Kovacˇ , University of Zagreb
Presented By Syed Ali Raza

2. What is E-Health
 Refers to incorporating information and
ICT into:
Healthcare products, services, and
processes
Organizational and governmental
infrastructures that can improve patient-
citizens’ health and well-being
 Increases efficiency and productivity in
healthcare delivery

3. Trends
 Healthcare costs could double among EU
member states by 2060
 If trends over the past 3 decades
continue,
Healthcare costs in US will climb as much
as 7 percent annually for the foreseeable
future

4. What E-Health could do to save
this cost
 Internationally, the telemedicine market
topped with US$13.8 billion in 2012
 Expected to grow at a 16.9 % compound
annual rate, to US$35.1 billion in 2018.

5. Internet Trends
 Pew Research Health Online 2013 study:
 81 % of US adults having regular Internet
access,
 59 % of those studied had used the Internet to
look online for health information during the
previous year.
 7 in 10 track a health indicator for themselves
or a loved one
 21 percent use some form of technology to
track health data

6. Barrier in Implementing E-
Health
 At government levels is the failure to
consider the need for interoperability
among systems and services

7. INTEROPERABILITY
Enables health information and medical
expertise to be exchanged among
clinicians, patients, and others.

8. Stakeholders

9. Stakeholders (contd..)
 Clinicians
 Require access to detailed health records in order to
manage healthcare
 Patients
 To exercise individual, informed autonomy over their
healthcare
 They want direct access to multiorganizational
healthcare records (possibly integrated to their PHR)
 Private providers, national and regional
health services
 Need real-time, fine-grained business intelligence
regarding healthcare costs, quality, and outcomes.

10. Interoperability framework

11. Legal interoperability
 Focuses on aligning legislation so that
information exchange conforms to established
legal procedure
 Most important are directives:
 To protect personal data
 To provide a community framework for electronic
signatures
 To establish patients’ rights in cross-border
healthcare
 Regulations on data protection, on e-IDs and on
medical devices;
 Recommendations regarding e-health
interoperability and telemedicine

12. Organizational interoperability
 Focuses on coordinating processes of
organizations to realize mutually agreed
upon goals.
 Governments ultimately occupy the highest
stakeholder level
 International standardization bodies are
important partners in this process.
 Instantiation and support for cross-border
licensing and certification of quality also play
an important role

13. Semantic interoperability
 Aims to establish precision in the meaning
of exchanged information
 For this aim, Systems are developed for
 Concept representations
 Clinical models that assemble data items
 EHR information models
 Provenance context
 Challenge is “multiple standards”

14. Technical interoperability
 Aims to address technical coherence
among connected information systems
and services
 Such as interoperable identification and
authentication

15. epSOS (European Patients Smart
Open
Services)
 Focuses on improving medical treatment
for EU citizens traveling outside their
home countries
 Provides individual patient data
electronically to health professionals
within the pilot program
 Primary services to facilitate cross-border
interoperability are:
a patient summary
e-prescriptions

17. epSOS
 IHE profiles and CDA
 Security policy is based on ISO/IEC TR 13335
specifications
 epSOS deliverables, components, and pilot
infrastructure are also used in other projects:
 e-SENS
 STORK
 Trillium Bridge project

18. ACHIEVING E-HEALTH
INTEROPERABILITY: KEY
PRINCIPLES

19. The Croatian Central Healthcare
Information System (CEZIH)
 Currently Connecting more than 2,300 general
practitioner offices
 250 pediatric care facilities and 250 women’s health
clinics
 2,000 dental offices,
 150 locations providing medical care specifically for
school children,
 120 laboratories and 1,300 pharmacies
 1,100 specialist outpatient care facilities
 Offers functionalities to facilitate data exchange among
more than 60 hospitals;
 This framework includes over 60 ICT vendors
providing software and services.

21. Interoperability achievements
 For semantic interoperability,
 All software vendors use HL7 message
specifications to develop functionalities for data
communication.
 Technical interoperability addressed:
 By enforcing the use of Web services,
establishing HL7 Version 2 and Version 3 as
compatibility standards
 Use of common public key infrastructure with
X509 certificates
 Patient information can only be accessed using
smart cards, and all messages are digitally signed

22. Interoperability achievements
(contd..)
 Legal interoperability
 Comprehensive legislation being done to support
interoperability and new service integration
 Patient centricity
 e-prescription for patients with both short-term
conditions and chronic diseases
 e-referral to biochemistry laboratories
 automatic insurance status validation
 medical summary following patient
 Immunization side-effects reports

23. Interoperability achievements
(contd..)
 Overall interoperability has been verified
against thousands of sample use cases
executed in:
 common testing environments
 production environments

24. Success Indicators
 On average, it processes over 50 million e-
prescriptions yearly, 15 million e-referrals, and
48 million practitioners’ reports.
 E-referrals have significantly reduced patient
travel: 15,000 people per day
 E-prescription has reduced thousands of
prescribing errors.
 e-referral and e-prescription services can
potentially reduce equivalent CO2 emissions
by up to 15,000 metric tons per year

25. Lesson Learned
 Required documents for legal interoperability, while
similar in complexity, will likely take longer to pass as
national legislation
 Organizational change will definitely be significantly
greater and more complex due to a larger stakeholder
pool
 Semantic issues will differ little; good practices in
smaller systems can be replicated in larger ones
 Clients access the central system through the Internet
using regional government–provided X509 certificates
for authentication
 The necessary requirements within regions meet
epSOS specifications